I thought that TB was pretty much non existent in the west, existing in very poor areas at a low level.
"The 50 states and the District of Columbia (DC) report cases to the national TB surveillance system at CDC by using a standard case definition and report form (2). Data were analyzed for cases reported during 1998--2003 by using reports updated as of February 24, 2004. A U.S.-born person was defined as someone born in the United States or its associated jurisdictions, or someone born in a foreign country but having at least one U.S.-born parent; other persons were classified as foreign-born. U.S. Census population estimates were used to calculate national and state TB rates for 2003 (3), and the Current Population Survey (March 2002) was used to extrapolate the total U.S.-born and foreign-born populations for 2003 (4). The 2002 U.S. Census population estimates were used to extrapolate and calculate race/ethnicity TB rates for 2003 (5,6). U.S. Census Bureau national population estimates were used to calculate the U.S.-born, foreign-born, and racial/ethnic populations for 1998 (7,8).
During 2003, a total of 12 states and DC reported rates above the national average (5.1 cases per 100,000 population), and 24 states met the definition for low incidence (<3.5 cases per 100,000 population) (Table 1). Among the 19 states that reported increases in cases during 2002--2003, California, New York, and Texas accounted for 42.4% of the 2003 national case total. Among those areas reporting <100 cases in 2003, only Alaska and DC had rates higher than the national average (Table 1).
In 2003, foreign-born persons accounted for 53.3% (7,845 cases) of the national case total, and 25 states reported >50% of their cases among foreign-born persons. The foreign-born prevalence represents an increase from 1998, when foreign-born persons accounted for 41.7% (7,598) of TB cases nationwide, and 13 states reported >50% of their cases among foreign-born persons. The 2003 TB rate among foreign-born persons (23.4 cases per 100,000 population) was 8.7 times greater than that among U.S.-born persons (2.7 cases per 100,000 population), representing an increased rate ratio from 1998 (7.0) and from 2002 (8.0). For the top three reporting states (California, New York, and Texas), the 1998--2003 decrease in cases among U.S.-born persons (32.2%; from 3,179 to 2,155) was four times greater than the decrease among foreign-born persons (7.6%; from 4,420 to 4,086).
In 2003, the five birth countries of foreign-born patients with TB reported most commonly were Mexico (25.6%), the Philippines (11.6%), Vietnam (8.4%), India (7.7%), and China (4.8%). TB patients from certain countries were concentrated in certain states. For example, New York reported 56.1% of the national total born in Ecuador, Minnesota reported 55.2% of patients born in Somalia, California reported 52.3% of patients born in the Philippines, and Florida reported 49.4% of patients born in Haiti. Among 6,429 foreign-born TB patients aged >15 years, 3,410 (53.0%) had resided in the United States >5 years before TB diagnosis, 1,778 (27.7%) resided in the United States 1--4 years, and 1,241 (19.3%) resided in the United States <1 year.
Disparities in TB rates persist among racial/ethnic minority populations. In 2003, two modifications were made to the TB report form: 1) multiple race entries were allowed, with 0.3% selecting more than one race, and 2) the previous category of Asian/Pacific Islander was divided into "Asian" and "Native Hawaiian or Other Pacific Islander." During 2003, the highest rates were reported among racial/ethnic minority populations (Table 2). The non-Hispanic black population had the largest number of TB cases (3,041 cases, 45.0%)."
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